Are Cherries a Cure for Gout?
Scientists are putting this popular folk remedy to the test, with promising results.
High-purine foods like red meat and beer contribute to gout because they increase uric acid in your blood. But what about foods that lower uric acid and help protect joints? That’s where cherries come in. Research stretching back decades has shown that cherries decrease the chance of gout attacks, reduce disease severity and lower uric acid — usually within a few hours. A growing number of studies show they may also help many other health problems, including osteoarthritis, insomnia, heart disease, dementia, cancer and even muscle recovery after exercise.
The benefits seem to come mainly from anthocyanins. These deep red, blue and purple plant pigments found in berries, grapes and plums, for examples, have powerful antioxidant and anti-inflammatory properties. They may also help prevent long-term bone damage. Cherries have more anthocyanins than most other fruits, including blueberries, which have long topped the list of antioxidant-rich foods. Cherries are also high in vitamin C and the flavonoid quercetin, which may lower uric acid or stop it from forming.
Tart Cherry Studies
There are dozens of varieties of cherries, but only two types: sweet and tart. Although sweet Bing cherries have more anthocyanins than tart cherries like Montmorency, most research has focused on tart cherries, especially concentrated forms like juice, extracts and supplements. Fresh cherries are delicious but harder to standardize in studies and, as a gout preventive, provide less bang for your buck.
Two small studies, more than a decade apart, illustrate the difference between fresh cherries and cherry concentrate. In one study, eating 45 fresh Bing cherries lowered blood uric acid by 14%. In the second study, one ounce of tart cherry concentrate — the equivalent of about 90 cherries — reduced uric acid by nearly three times as much.
Liquid cherry extract (found in natural food stores and online) appears to provide similar benefits. In a small, retrospective study of 24 patients, researchers at Robert Wood Johnson Medical School in New Brunswick, N.J., saw a 50% reduction in flares when gout patients took one tablespoon of tart cherry extract — equal to about 45 to 60 cherries — twice a day for four months.
In 2019, researchers reported a significant drop in uric acid among people who drank 8 ounces of diluted tart cherry juice concentrate every day for four weeks. Study participants, who were overweight or obese and at risk of metabolic syndrome, also had a nearly 20% drop in C-reactive protein (CRP), a common measure of inflammation in the body.
Also in 2019, a review of six studies found that tart cherry juice significantly lowered uric acid and led to less severe disease and fewer reported gout flares.
Cherries vs. Allopurinol
Most gout treatment guidelines recommend uric acid-lowering drugs like allopurinol for patients who have frequent gout attacks or joint damage on imaging tests. The American College of Rheumatology (ACR) conditionally recommends gout medication for people who have just two flares a year. Yet only about 20% of patients stick with gout medication, in part because of side effects such as nausea and vomiting.
ACR guidelines also recommend that patients take nonsteroidal anti-inflammatory drugs (NSAIDs), prednisone or colchicine along with allopurinol for three to six months. This helps lower the risk of flares — a frequent problem when starting gout drugs. Yet all of these medications may have potentially serious side effects, especially in older adults and when taken for more than a few days.
Another concern is that certain African Americans and people of Southeast Asian descent are more likely to have a potentially life-threatening reaction to allopurinol compared to other ethnic and racial groups. The next-best alternative, febuxostat, increases the risk of heart disease-related death, which is already higher in Black Americans.
Some experts think the evidence supports using cherries to prevent and manage gout (preferably in combination with a healthy eating plan like the Mediterranean diet) or as an adjunct to drugs like allopurinol. In one study, people who consumed cherry extract, one to four servings of fresh cherries (around 10 to 40 cherries) or both for two days had 35% fewer gout flares during a one-year follow-up period. Combining cherries in any form with allopurinol reduced flares by 75%.
Yet there are also problems with using cherries for gout management. The most effective forms and dosages aren’t known. And since cherries have never been compared head-to-head with allopurinol, it’s not clear how the two stack up. Plus, cherries are high in fructose, which could be a problem because many people with gout have or are at risk of diabetes. (Sugar isn’t an issue with cherry supplements.)
Until more is known, a specific cherry regimen isn’t advised. But many agree that for overall health and as a possible tool in managing gout, a handful of cherries, especially a tart variety such as Montmorency, or a glass of cherry juice every day can’t hurt.